Remedy our shortage of nurses

May 05, 2008|By Michael V. Relf and Elizabeth Wykpisz

The 2.9 million registered nurses in the United States provide clinical care in home and hospital settings. They perform leading research into best practices in health care access, delivery, quality and safety. Nurses keep communities healthy through comprehensive public health initiatives. And, perhaps most important, they educate the next generation of nurses.

Yet the profession faces a huge problem - one that could soon become a problem for all of America.

A report released in March on "The Future of the Nursing Workforce in the United States" says the shortage of registered nurses could reach 500,000 by 2025. An older report by the federal Health Resources and Services Administration projects a shortage of more than 1 million registered nurses by 2020, including 5,600 in the District of Columbia, 18,200 in Maryland and 26,300 in Virginia.

Solving the nursing shortage will require a multi-pronged approach that involves educational innovations, government programs and clinical reforms.

A major element of the coming shortage involves the aging of the nursing workforce, including faculty members to teach new nurses. In the next two years, as the Government Accountability Office noted in 2001, about 40 percent of nurses will likely be more than 50 years old. This dilemma in the nursing field mirrors an even harsher reality: the aging of the country's baby boomer generation. Unfortunately, the smaller trend and the larger one affect each other negatively.

In 2004, the Centers for Disease Control and Prevention and the Merck Institute of Aging and Health released staggering statistics. Starting in 2012, approximately 10,000 people in the United States will turn 65 each day. By 2030, 20 percent of all Americans will be 65 or older. And by midcentury, almost 19 million people will be over 85.

Who will help care for America's aging and geriatric population? We must think creatively about remedies for the nursing shortage and swiftly implement ideas.

One method is for educational and clinical organizations to address the problem together by producing a workforce pipeline. Earlier this year, Washington Hospital Center and the School of Nursing and Health Studies at Georgetown University Medical Center partnered to establish a $2 million scholarship program. Adults with a bachelor's degree or higher in another field can earn a bachelor's degree in nursing in 16 months.

With the shortage in mind, we aimed to create a program to recruit, educate and retain a front-line nursing workforce. Our inaugural program will graduate 28 new nurses. In the next several years, with additional financing, we will expand the program to graduate a total of 230 nurses. Graduates will work for at least three years at Washington Hospital Center, including on the geriatrics unit.

Another key approach lies at the federal and state levels. In February, Gov. Martin O'Malley announced the allocation of $3.4 million to the University of Maryland's School of Nursing to address the shortage through enhanced and expanded space, faculty and staff recruitment, and tuition for additional students.

A third crucial step is for clinical organizations to take a much-needed inward look at retaining nurses through workplace satisfaction and employee engagement. A solid strategy includes involving the professional nursing staff as decision-makers, fostering collaborative relations among nurse leaders, physicians, and other members of the health care teams, and offering competitive salaries and associated benefits.

National Nurses Week kicks off tomorrow. The best way to celebrate what nurses do for us is to think about how to keep this vital profession alive. The health of our nation depends on it.

Michael V. Relf chairs the Department of Nursing at Georgetown's School of Nursing and Health Studies. His e-mail is mrelf01@georgetown.edu. Elizabeth Wykpisz is interim chief nursing officer at Washington Hospital Center. Her e-mail is elizabeth.wykpisz@medstar.net.